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Author Topic: PFJPS - really bad  (Read 3131 times)

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Offline Jasey122

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Re: PFJPS - really bad
« Reply #15 on: December 04, 2017, 07:47:18 am »
Hello,

I have also fat pad impingement, but now I have pain in the medial part of patella, before I had on lateral of patella.

Where is your painful part of knees?

I can't really say where the pain is coming from as it varies literally, from within the knee cap were I get sharp pains, to above the knee cap and then below the knee cap from the fat pad.   I know this sounds vague. Whats your story and what have you tried?

Offline Clarkey

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Re: PFJPS - really bad
« Reply #16 on: December 07, 2017, 09:30:25 pm »
I am also in the KG members fat pad impingement club that was the only problem spotted in my MRI scan back in 2008 with fluid around the fat pad. I had PT and a cortisone injection after feeling lateral catching that did not improve the pain and discomfort. Was not able to run so opted for a diagnostic arthrocopy in November 2009, I had my fat pad trimmed and medila plica excsion, slow recovery of 18 months before I was able to run again long distances.

Fell onto my right knee on black ice in January 2013! Since then not been able to run with another scope of anterior interval release AIR surgery in July 2014 for excessive scar tissue build up. Having a 3rd scope on January 2018 for patella decompression surgery and maybe AIR surgery once again. 

Need to think carefully before going ahead with surgery on the fat pad! It's a risky procedure and hear of many failed attempts causing excessive scarring that can potentially cause arthrofibrosis of the knee that once you have it is hard to eradicate.

Anterior knee pain is very common as the bottom of the kneecap is where the damage occurs that can be eased loosing weight. If you are at a healthy weight like me, seeing a sports physiotherapist for strengthening exercises was helpful. As we age the knee starts to wear out slowly with PFPS as the first signs. If you can get your quads nice and strong will benefit you if you opt for surgery as the last resort after all conservative treatments have failed, you will recover quicker with strong quad muscles.

Good luck.

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« Last Edit: December 07, 2017, 09:32:16 pm by Clarkey »
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline Clarkey

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Re: PFJPS - really bad
« Reply #17 on: December 09, 2017, 05:16:40 pm »
Hello,

I have also fat pad impingement, but now I have pain in the medial part of patella, before I had on lateral of patella.

Where is your painful part of knees?

I can't really say where the pain is coming from as it varies literally, from within the knee cap were I get sharp pains, to above the knee cap and then below the knee cap from the fat pad.   I know this sounds vague. Whats your story and what have you tried?

Have recently felt sharp shooting pain at the top of my right kneecap on the lateral side while walking with medial lateral pain at the bottom! Have to stand till the pain eases again with crippling pain struggling to walk for around 12 seconds before pain has eases again. Strongly suspect it is the fat pad and hitting a nerve is my guess that might be the same with the pain and discomfort that you are also experiencing with similar symptoms. Showing clearly problems associated with the fat pad. Pain can be hard to pinpoint at times, mine is mainly at the bottom of the tibia, if I try to increase my pace the pain is there straight away.

My walking pace has gradually slowed down, will risk a 3rd scope in January was earning money self employed doing gardening around my neighbourhood earning £10 an hour September until October after unfair dismissal as an autism support worker. Right knee is a hindrance increasing the limping after gardening. There might be some damage to the cartilage is my gut feeling! Hoping more problems gets spotted during surgery. Need to earn a regualr salary, highly in demand my gardening skills with five clients with limited hours before the knee starts to flare up.

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« Last Edit: December 09, 2017, 05:20:57 pm by Clarkey »
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline adamas

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Re: PFJPS - really bad
« Reply #18 on: March 21, 2018, 10:18:13 am »
I went to see Claire and she was extremely informative and such a nice lady. She mentioned having a high riding patella which was not well supported by the muscles , so in her opinion strengthening was the way to go , cos if  not the patella would just keep impinging the fat pad and other structures. I'll give this a go for a while and see how I get on. She's adjusted my exercises so hopefully this does not cause any pain.  Thanks for your recommendation vickster

How was your experience with Claire? I live in England and I am thinking of seeing her myself. Hope it is worth the very high fees...

Has she said anything about PRP injections? I am struggling in finding anyone in the UK who is knowledgeable about that.

Offline Vickster

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Re: PFJPS - really bad
« Reply #19 on: March 21, 2018, 11:51:47 am »
You wonít get PRP in the U.K. on the NHS and certainly not stemcells (at least not outside a research project)

Pretty sure Adrian Wilson offers privately but kneecaps arenít his particular speciality. Jonathan Eldridge and Anan Shetty are kneecap experts, donít know if they offer PRP. The evidence for cartilage is still under scrutiny
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
More tears and wear, scope planned in Jan 2019 to tidy up

Offline adamas

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Re: PFJPS - really bad
« Reply #20 on: March 21, 2018, 12:58:50 pm »
You wonít get PRP in the U.K. on the NHS and certainly not stemcells (at least not outside a research project)

Pretty sure Adrian Wilson offers privately but kneecaps arenít his particular speciality. Jonathan Eldridge and Anan Shetty are kneecap experts, donít know if they offer PRP. The evidence for cartilage is still under scrutiny

Well, I have always planned on self-paying for PRP. It has been 8 months since this knee issue started and, so far, I had self-paid every diagnostics, OS and PT I saw. If I have waited for the NHS, I would still be stuck at going to my GP just to keep hearing "there's nothing broken, it's just a matter of time and it will go away on its own..." and clearly no referral whatsoever   

Offline Vickster

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Re: PFJPS - really bad
« Reply #21 on: March 21, 2018, 01:31:55 pm »
Whatís your specific issue? PFS?
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
More tears and wear, scope planned in Jan 2019 to tidy up

Offline adamas

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Re: PFJPS - really bad
« Reply #22 on: March 21, 2018, 02:38:44 pm »
Whatís your specific issue? PFS?

Yes, it is PFS on both knees. I had MRIs on both knees that show grade 1 chondromalacia patellae, but according to one knee OS I saw and to the PT, it is the tissue around the patella that is inflamed and causes pain, rather than being due to cartilage loss (grade 1 is just softening of the cartilage) or arthritis.

After having done some reading on this forum, I really think that Dr. Dye's theory about loss of tissue homeostasis is the real culprit. In my case, I am not actually getting more pain when walking, going up or down stairs or doing leg press, leg extension and other exercises. I have a rather constant burn on the medial side of the knees and what really increases it is prolonged sitting (regardless of keeping the legs bent or straight) and, even worse, driving.

One of the knee OS I saw proposed me a set of two PRP shots on both knees, that should help having an anti-inflammatory effect.
« Last Edit: March 21, 2018, 02:41:33 pm by adamas »

Offline Vickster

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Re: PFJPS - really bad
« Reply #23 on: March 21, 2018, 02:59:14 pm »
Hyaluronic can have a similar effect. Or an extended course of anti inflammatories (+stomach protector)

Iím sure Claire would have some good advice, thereís some great stuff on her website too

Good luck.
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
More tears and wear, scope planned in Jan 2019 to tidy up

Offline adamas

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Re: PFJPS - really bad
« Reply #24 on: March 21, 2018, 03:10:21 pm »
Hyaluronic can have a similar effect. Or an extended course of anti inflammatories (+stomach protector)

Iím sure Claire would have some good advice, thereís some great stuff on her website too

Good luck.

I did a hyaluronic acid injection, but it had no effect whatsoever. Hyaluronic acid is useful when there is cartilage damage, as it acts mostly as a lubricant in place of the missing cartilage. The fact that it did nothing to me makes me believe that the cause of my PFS is really inflammation of the soft tissue around the patella.

Unfortunately I cannot take any NSAIDs because of a bowel condition, so that will never be an option for me, even though it may really help.

Offline Vickster

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Re: PFJPS - really bad
« Reply #25 on: March 21, 2018, 03:27:46 pm »
I did find I recovered from post arthroscopy inflammation with Durolane in my worn knee but agree it doesnít work for all

 
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
More tears and wear, scope planned in Jan 2019 to tidy up

Offline Jasey122

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Re: PFJPS - really bad
« Reply #26 on: March 22, 2018, 01:18:44 am »
I went to see Claire and she was extremely informative and such a nice lady. She mentioned having a high riding patella which was not well supported by the muscles , so in her opinion strengthening was the way to go , cos if  not the patella would just keep impinging the fat pad and other structures. I'll give this a go for a while and see how I get on. She's adjusted my exercises so hopefully this does not cause any pain.  Thanks for your recommendation vickster

How was your experience with Claire? I live in England and I am thinking of seeing her myself. Hope it is worth the very high fees...

Has she said anything about PRP injections? I am struggling in finding anyone in the UK who is knowledgeable about that.


Claire is very knowledgeable and I really do recommend her. I have seen a lot of progress since I saw her. I am not where I want to be yet but I've seen so much progress. She gave an overall opinion and then  reccomended another physiotherapist that she works with, and the two of them are working on my progress. So Ill definitely say go see her first before seeing other doctors.

I did enquire about PRP at Fortius Clinic. They thought the evidence was neither here nor there, but it couldn't do any harm were there thoughts. They do PRP but it was expensive. I didn't go ahead with it.
« Last Edit: March 22, 2018, 08:21:10 am by Jasey122 »

Offline adamas

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Re: PFJPS - really bad
« Reply #27 on: March 22, 2018, 09:09:58 am »
I went to see Claire and she was extremely informative and such a nice lady. She mentioned having a high riding patella which was not well supported by the muscles , so in her opinion strengthening was the way to go , cos if  not the patella would just keep impinging the fat pad and other structures. I'll give this a go for a while and see how I get on. She's adjusted my exercises so hopefully this does not cause any pain.  Thanks for your recommendation vickster

How was your experience with Claire? I live in England and I am thinking of seeing her myself. Hope it is worth the very high fees...

Has she said anything about PRP injections? I am struggling in finding anyone in the UK who is knowledgeable about that.


Claire is very knowledgeable and I really do recommend her. I have seen a lot of progress since I saw her. I am not where I want to be yet but I've seen so much progress. She gave an overall opinion and then  reccomended another physiotherapist that she works with, and the two of them are working on my progress. So Ill definitely say go see her first before seeing other doctors.

I did enquire about PRP at Fortius Clinic. They thought the evidence was neither here nor there, but it couldn't do any harm were there thoughts. They do PRP but it was expensive. I didn't go ahead with it.

Thanks for the feedback, I am going to see her. What exercises did she suggest for your situation?

Regarding PRP, do you recall how much the clinic charges for a shot?


Offline Jasey122

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Re: PFJPS - really bad
« Reply #28 on: March 22, 2018, 07:45:23 pm »
I went to see Claire and she was extremely informative and such a nice lady. She mentioned having a high riding patella which was not well supported by the muscles , so in her opinion strengthening was the way to go , cos if  not the patella would just keep impinging the fat pad and other structures. I'll give this a go for a while and see how I get on. She's adjusted my exercises so hopefully this does not cause any pain.  Thanks for your recommendation vickster

How was your experience with Claire? I live in England and I am thinking of seeing her myself. Hope it is worth the very high fees...

Has she said anything about PRP injections? I am struggling in finding anyone in the UK who is knowledgeable about that.


Claire is very knowledgeable and I really do recommend her. I have seen a lot of progress since I saw her. I am not where I want to be yet but I've seen so much progress. She gave an overall opinion and then  reccomended another physiotherapist that she works with, and the two of them are working on my progress. So Ill definitely say go see her first before seeing other doctors.

I did enquire about PRP at Fortius Clinic. They thought the evidence was neither here nor there, but it couldn't do any harm were there thoughts. They do PRP but it was expensive. I didn't go ahead with it.

Thanks for the feedback, I am going to see her. What exercises did she suggest for your situation?

Regarding PRP, do you recall how much the clinic charges for a shot?

I do exercises to build my calf muscles, gluten, and quads, using blood flow restriction training which helps to build muscles really quickly. If you need the actual names let me know.  As I build muscle, the exercieses change.

Single leg bridge 10reps x 4 (both sides) Ė no rest between
Sit to stand - full range 10reps x 6sets, 30secs recovery between sets, cuff up to 100mmgh for the entire time

Seated heel raises 50reps x 2 Ė weight on the knees Ė only tap the heels on the floor, feet behind the line of the knees - weight on the knees 2 x 12kg+
1 leg calf 25reps each side  x 4 - weight in the hand of the stance leg

Step back lunge with hands on the kitchen side 15-25reps each side x 4

Single leg stand 45secs on 1 leg, 15secs recovery x 4 with the cuff up to 100mmgh for the entire time

Cant remember the cost so I suggest you call the clinic. were I to guess, it was over £1,000.

« Last Edit: March 22, 2018, 07:47:06 pm by Jasey122 »

Offline SuspectDevice

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Re: PFJPS - really bad
« Reply #29 on: March 22, 2018, 10:34:42 pm »
Whatís your specific issue? PFS?

Yes, it is PFS on both knees. I had MRIs on both knees that show grade 1 chondromalacia patellae, but according to one knee OS I saw and to the PT, it is the tissue around the patella that is inflamed and causes pain, rather than being due to cartilage loss (grade 1 is just softening of the cartilage) or arthritis.

After having done some reading on this forum, I really think that Dr. Dye's theory about loss of tissue homeostasis is the real culprit. In my case, I am not actually getting more pain when walking, going up or down stairs or doing leg press, leg extension and other exercises. I have a rather constant burn on the medial side of the knees and what really increases it is prolonged sitting (regardless of keeping the legs bent or straight) and, even worse, driving.

One of the knee OS I saw proposed me a set of two PRP shots on both knees, that should help having an anti-inflammatory effect.

Yup, sounds like a classic case of Dr Dye loss of tissue homeostasis to me, esp. the burning pain.  I had 3x PRP in both knees and really it did nothing, so don't waste your $'s.  A long-term course of Celebrex was the key to breaking the inflammation cycle, but you say you can't take them.  That leaves only the Richard Bedard 'Saving My Knees'/Paul Ingrham PFPS option - avoiding everything...EVERYTHING! that aggravates them, but do enough gentle movement to let them heal.  Sounds like gentle walking is OK for you which is great news, as that was a big part of my recovery regime (20-30mins easy each morning).  I also sat at my desk with legs extended on a box for years - still do mostly.  Be very careful with strengthening exercies - I'm not saying don't do them, but by trial and error work out which ones aggravate & don't do them, and which ones you can get away with.  You might be surprised, for example deadlifts were OK for me, but any kind of squatting (except sissy squats) or seated leg extensions were bad.
L Medial menisectomy 2012
PFPS in both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2018 - Started basic MTB racing, maybe try short triathlons in October?















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